Emotional Intelligence: A Consumer's Guide to Psychological Treatment

130 different "brands" of psychological treatment

FDA FOR PSYCHOLOGICAL TREATMENTS?Before a drug can be marketed, it must undergo extensive testing and finally receiveapproval from the Food and Drug Administration (FDA),which ascertains thatit is safe, beneficial. and effective. And from time to time, we hear that substancessuch as saccharin, which we had hitherto thought to be safe, may be dangerousand quite possibly should be taken off the market. Should there not be such an FDAfor psychological treatment?

There are estimated to be some 130 different"brands" of psychological treatment available (PariaH), and the numbergrows annually. All of these are beneficial; some may be harmful to some peopleor have negative side effects. Should there not be systematic evaluation ofthese treatments before they are made available to the public?

Gerald Klerman, the former chief of the Alcohol, Drug Abuse, and MentalHealth Administration (ADAMHA) argues that such systematic evaluation must takeplace if only because the consumer movement end the pending Notional HealthInsurance require it. Klerman points to the need to circumscribe legitimate mentalhealth activity.

He says:We can attack the problem of defining boundaries in part by returning to thepractical problem that many therapeutic methods ore well-intended, but poorly established in terms of safety, efficacy and economy. One cannot demonstrate mark, however, is that they are precise and replicable, and they stay quite close to the client's initial complaints.

These kinds of assessments are the benchmark of the action therapies;they have been very useful in demonstrating the effectiveness of these kindsof treatments. Indeed, they are largely responsible for the growing popularityof the action therapies, among both clients and therapists. But they arenot entirely without hazards. Some behaviors are elusive and difficult tomeasure with precision and reliability. Problems of meaning are amongthese. Some complaints, moreover, are very complex and intertwined. Thepresence of multiple phobias, for example, which extend over a range of environmentsand stimuli, makes assessment complex and difficult, In themain, however, behavioral change, where it can be assessed, is the "kingpin"of measures of therapeutic effectiveness.

THE VARIETY OF TREATMENTIt has recently been estimated that clients can choose from among 130 different"brands" of therapy (Parloff, 1976). Each year the number of therapiesgrows. And, of course, each "therapy" has its loyal adherents whoconfidently proclaim its efficacy for a host of problems. Behavior modification,Rolfing, insight therapy, rebirthing, cognitive therapy, lithium, flooding,these and dozens more are possible choices. Unfortunately, it is extremelydifficult to make informed choices. While claims for success arebroad, the evidence is slim. Only a few controlled tests have been conductedto assess the effectiveness of particular therapies, and even fewer tests havebeen done to compare the relative efficacy of various treatments. Equallyimportant, little is known about the possible harmful effects a therapy mighthave. There is no protection for the consumer of therapy analogous to theprotection afforded the consumer of drugs . The Federal Drugthe efficacy of a therapy in terms of the intentions of its proponents.... Neithercan a therapy be considered routine and acceptable on the basis of the testimonyof authorities that is, because outstanding members of the professionare of the opinion that it is useful, safe and effective. I believe that only evidenceas to outcomes will suffice in the rigorous climate of consumerism and health insurance coverage. (A.P.A. Monitor, 1979, p. 9)

The argument for evaluating therapies before they are available in the marketplaceis perfectly straightforward, but deceptively simple. Nicholas Cummings,former president of the American Psychological Association and a longtime studentof psychotherapy, points out that a proper evaluation of the available therapiesmight take as long as twenty years (Marshall, 1980). What are we to do inthe meantime? Simply let people suffer?A more fundamental issue, however, arises from the nature of psychological treatment itself. Does psychological treatment come in the same kinds of measurable doses as, say, saccharin or red dye #2?

Clearly not, for we have alreadyseen that the non specific effects of psychotherapy are quite different from the veryspecific effects of saccharin. For saccharin's effects will occur irrespective of thecircumstances under which it is taken, while psychotherapy's effects depend onthe circumstances-the individuals under treatment, their hopes and expectations,the characteristics of the therapist, and other hard-to-measure variables. Administration imposes stringent testing procedures on all new drugs beforethey can be marketed: they must be effective; they must be relatively harmless;side effects must be clearly stated. No governmental agency acts aswatchdog in the case of psychotherapy. Claims can be made with no concernfor evidence. Psychoanalysis, it will be recalled, was practiced for morethan a half century before its claim that it was an effective treatment wasscrutinized.